New Orleans EMS Chief Details New Year's Day Response

New Year’s Day in New Orleans “took our innocence away” said Bill Salmeron, New Orleans EMS chief. EMS crews are trained for mass casualty incidents, but this one was different “in the way it happened and what happened,” he said. “The reality of we are a target hits home a lot more.”

The actions of an assailant driving a pickup truck into a crowd celebrating on Bourbon Street in New Orleans at 3:15 a.m. resulted in 15 deaths­—including his own during a shootout with police—and injuring at least 35 others, including two police officers who were shot. EMS and police initially treated the incident as a vehicle ramming.

“When this first happened, the radio lit up with ‘I need EMS here, EMS there.’ The police would not be calling for us if the scene was not safe,” Salmeron said.

As the incident progressed with additional hazards such as guns and improvised explosive devices (IED), the police instructed medics to retreat. The incident “definitely is going to cause us some pause when it comes to future plans and how we respond,” Salmeron said. “We thought New Orleans has always been a soft target for terrorism. We realize we have the world's biggest free party during Mardi Gras. It’s very easy for someone to do something.”

Prior to Mardi Gras each year, New Orleans EMS undergoes mass casualty incident (MCI) training in policies, practices, and disaster management tabletop exercises.

“We have multiple scenarios to hone triage skills,” Salmeron said, adding EMS is a “very busy service” in a city that has experienced multiple shooting incidents.

“We do a full-scale, on-the-ground exercise with all of our regional partners,” Salmeron said. “We try to involve the hospitals as much as possible. It gives the hospitals an opportunity to practice what facilities need to do and how to move people in their systems.”

New Orleans EMS crews “have gotten really good doing quick assessments and moving sick folks off the scene really fast,” he adds.

MCI training includes the decision-making criteria involved if the city experiences multiple traumas. “The worst ones go to the trauma center, and then we're able to send the secondary to other facilities,” Salmeron said, adding that was the approach on New Year's Day.

Salmeron notes New Year’s Day was treated like any large special event with increased staffing—including command staff—emergency vehicle staging, alternative support apparatus (ASAP) carts, and bike units in New Orleans’ hospitality zone.

“We had two ASAP carts with a supervisor assigned to French Quarter hospitality to handle the call volume we would get from that area in addition to our citywide call volume,” Salmeron said. “When calls come in, special event units handle calls within that zone and everybody else would handle citywide calls.”

Salmeron noted one New Orleans medic witnessed the assailant turn from Canal Street onto Bourbon Street. “Our staff was there and immediately responded,” Salmeron said. “They started to call for assistance and went to work. The call originally came into the call center at 3:17 a.m. Our special event team started to make their way down Bourbon Street, assess patients and get people moved where they needed to be for transport.”

The response involved 25 EMS personnel, 12 additional mutual aid personnel, and eight ambulances, including six from other services to assist. The fire department helped with emergency medical response.

“The streets are very tight,” Salmeron said of the French Quarter. “The best way to get trucks in is [via] Canal Street. When something happens on the French Quarter or on Bourbon Street, you have to move cars, barricades, temporary bollards, and different things. We worked with the police department to make sure we had a good casualty collection point a block in from Canal [where] crews could go through a several block area and start to move people out that had to be moved—the green, yellow and red patients.”

Salmeron said the biggest challenge was the “sheer number of patients. We’re very used to mass casualties. We’re used to the reds, yellows, and the walking wounded. We’re not used to a lot of deceased. A big thing was when you started to realize how many people were killed in this incident.”

The incident involved managing expectations, Salmeron said. In mass casualty incidents, “we go from individual patient care to we look for the greater good and treat as many people as we can,” he said. “Those that are deceased we don’t work on. But we had family with the deceased screaming for us to help them. That affected our folks. When you join EMS, you want to help and you’re here to save lives. To leave someone and not do something because you have to go treat someone else is hard. Not many folks in EMS have experienced a large mass casualty.”

Salmeron notes there were more than 300 police officers on duty in the area representing different agencies and provided help treating and carrying patients.

Two casualty collection points were established on Bourbon Street for the sickest patients. Those less injured were brought to Canal Street. Salmeron had worked normal New Year’s Eve coverage and left for home before the incident occurred. He took a call regarding a truck running over some people, resulting in three patients in need of care.

“I said, ‘OK, just call me back if there’s an issue.’ Then I turned the radio on and what hit me was staff calling out more dead patients,” he said, adding he went back to work to join incident command.

Footage from vehicle cameras and body cams New Orleans paramedics wear is being viewed as part of the investigation.

It was 95 minutes from the first call until the final patient transport. In the aftermath, those involved in the rescue efforts returned to their stations where they were told to punch out and take the time needed to decompress from the significant anxiety that emerged, Salmeron said.

“Supervisors put eyes on everyone as they were coming in,” he said. “We offered folks working the next couple of days the opportunity to take off to process stuff.” Some did; others did not.

There were four subsequent debriefings on all shifts for anyone experiencing feelings about the incident. “You didn't have to be on scene to feel it,” Salmeron said. “If you heard the radio traffic or came in the next day, you're also hurting with your team members.”

New Orleans EMS’ full-time mental health professional immediately engaged with staff. Mental health services were offered through the city’s Employee Assistance Program. “Our local University Medical Center did a ‘heart huddle’ and invited police, fire, EMS, and hospital—anyone who was a responder—to participate in a group session to talk about what they experienced,” Salmeron said.

Salmeron said the current priority is to “make sure our folks are okay. We are not putting them on TV, we're not doing interviews, we're not going to have them tell their story. We are in a place to be able to take care of immediate needs and try to address some longer-term needs, making sure whatever we do, we have resources in place to meet them wherever they are.”

Support also is coming through K9 therapy groups as well as the agency’s own dog, Frank.

Salmeron advised other agencies to have a plan including other agencies such as police and fire “you normally don't work with. You want to be able to know who they are. They need to know who you are and how you operate. You don't want to meet each other for the first time when you show up on scene to do something.” Even so, expect the unexpected and prepare to be flexible, Salmeron added.

Salmeron said one factor that sticks in his mind is what would have happened if an IED went off during the New Year’s Day incident and how it would have affected first responders.

“Moving forward, we're going to look at multiple risks,” he said. “It’s not just a car ramming, a bomb threat, or an active shooter by itself—it could be all of this combined. Make sure you have a plan for when your folks are engaged in this. How can you make sure your folks are safe, giving people the ability to say, ‘this is not safe and I’m going to pull back’ and making sure you support that decision and you have those resources that know each other.” Full scale exercises are key for optimal outcomes, he said.

Salmeron pointed out while first responders take care of other people, it’s important to emphasize taking care of themselves. He encourages EMS agencies to have a mental health plan and HR policies that align with that.

“I'm very proud of our team,” Salmeron said. “We handle so much as far as special events. We have MCIs on a regular basis. They saved lives that night. Our folks are phenomenal patient care providers.”

Salmeron also credits the city and others for ensuring safety for the Sugar Bowl, which had been delayed for 24 hours. “There was a lot of work that went into that 24 hours to screen everything and then get Bourbon Street re-opened in a respectful way,” he said. “We didn’t want to do anything to disrespect those who were lost in the incident. There was some stuff done to make sure there was a memorial.”

Similar safety measures are being applied for the upcoming Super Bowl. Salmeron noted that for the first time, Mardi Gras is going to be considered a Tier One federal event that will increase the federal resources to support the city.

“My staff is concerned” Salmeron said. “There’s justifiable stress around where we are and how safe are we. Between the local, state, and federal agencies involved right now, they’re going to guarantee this is going to be the safest time possible in New Orleans.

“I want everyone to feel safe coming to the city. I want my staff to feel safe. I tell my staff others can protect you to a certain point and that I need everybody to also be responsible for themselves and make sure that you know your environment. No matter where you are, always have a plan to get out of danger. Obviously, when you see something, say something.”